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<strong>Getting</strong> <strong>Started</strong><br />
<strong>with</strong> Evidence-Based<br />
Practices<br />
<strong>Supported</strong><br />
<strong>Employment</strong><br />
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES<br />
Substance Abuse and Mental Health Services Administration<br />
Center for Mental Health Services<br />
www.samhsa.gov
<strong>Getting</strong> <strong>Started</strong><br />
<strong>with</strong> Evidence-Based<br />
Practices<br />
<strong>Supported</strong><br />
<strong>Employment</strong><br />
U.S. Department of Health and Human Services<br />
Substance Abuse and Mental Health Services Administration<br />
Center for Mental Health Services
Acknowledgments<br />
This document was produced for the Substance Abuse and Mental Health Services Administration<br />
(<strong>SAMHSA</strong>) by the New Hampshire-Dartmouth Psychiatric Research Center under contract number<br />
280-00-8049 and Westat under contract number 270-03-6005, <strong>with</strong> <strong>SAMHSA</strong>, U.S. Department<br />
of Health and Human Services (HHS). Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as<br />
the Government Project Officers.<br />
Disclaimer<br />
The views, opinions, and content of this publication are those of the authors and contributors and<br />
do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services<br />
(CMHS), <strong>SAMHSA</strong>, or HHS.<br />
Public Domain Notice<br />
All material appearing in this document is in the public domain and may be reproduced or<br />
copied <strong>with</strong>out permission from <strong>SAMHSA</strong>. Citation of the source is appreciated. However,<br />
this publication may not be reproduced or distributed for a fee <strong>with</strong>out the specific, written<br />
authorization from the Office of Communications, <strong>SAMHSA</strong>, HHS.<br />
Electronic Access and Copies of Publication<br />
This publication may be downloaded or ordered at www.samhsa.gov/shin. Or, please call<br />
<strong>SAMHSA</strong>’s Health Information Network at 1-877-<strong>SAMHSA</strong>-7 (1-877-726-4727) (English<br />
and Español).<br />
Recommended Citation<br />
Substance Abuse and Mental Health Services Administration. <strong>Supported</strong> <strong>Employment</strong>: <strong>Getting</strong><br />
<strong>Started</strong> <strong>with</strong> Evidence-Based Practices. DHHS Pub. No. SMA-08-4364, Rockville, MD: Center<br />
for Mental Health Services, Substance Abuse and Mental Health Services Administration,<br />
U.S. Department of Health and Human Services, 2009.<br />
Originating Office<br />
Center for Mental Health Services<br />
Substance Abuse and Mental Health Services Administration<br />
1 Choke Cherry Road<br />
Rockville, MD 20857<br />
DHHS Publication No. SMA-08-4364<br />
Printed 2009
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong><br />
Evidence-Based Practices<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> Evidence-Based Practices gives you<br />
an overview of the activities that are generally involved in<br />
implementing EBPs and tells you how to make EBPs culturally<br />
competent. This booklet is particularly relevant to the following:<br />
n Mental health authorities; and<br />
<strong>Supported</strong><br />
<strong>Employment</strong><br />
n Agency staff who develop and manage EBP programs.<br />
For references, see the booklet The Evidence.
This KIT is part of a series of Evidence-Based Practices KITs created<br />
by the Center for Mental Health Services, Substance Abuse and<br />
Mental Health Services Administration, U.S. Department of Health<br />
and Human Services.<br />
This booklet is part of the <strong>Supported</strong> <strong>Employment</strong> KIT that includes<br />
a DVD, CD-ROM, and seven booklets:<br />
How to Use the Evidence-Based Practices KITs<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> Evidence-Based Practices<br />
Building Your Program<br />
Training Frontline Staff<br />
Evaluating Your Program<br />
The Evidence<br />
Using Multimedia to Introduce Your EBP
What’s in <strong>Getting</strong> <strong>Started</strong> <strong>with</strong><br />
Evidence-Based Practices<br />
Consensus Building: Build Support for Change ........3<br />
Integrate the EBP into Policies and Procedures ........5<br />
Assess Training Needs .........................7<br />
<strong>Supported</strong><br />
<strong>Employment</strong><br />
Monitor and Evaluate Regularly ..................9<br />
Maximize Effectiveness by Making Services<br />
Culturally Competent .........................11
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong><br />
Evidence-Based Practices<br />
Consensus Building:<br />
Build Support for Change<br />
Within a system, change affects<br />
stakeholders differently. Consequently,<br />
when making changes in the mental<br />
health system, mental health agencies<br />
should expect varied reactions from<br />
staff, community members, consumers,<br />
and families. Since misunderstandings<br />
can stymie your efforts to implement<br />
EBPs, it is important to build consensus<br />
to implement EBPs in the community.<br />
Practitioner training alone is not<br />
effective. The experience of mental<br />
health authorities and agencies that have<br />
successfully implemented evidencebased<br />
practices (EBPs) reinforces that<br />
fact. Instead, practitioner training must<br />
be complemented by a broad range of<br />
implementation activities, including the<br />
following:<br />
n Building support for the EBP;<br />
n Integrating the EBP into agency<br />
policies and procedures;<br />
n Training staff agency-wide on basic EBP<br />
principles; and<br />
n Allowing for ongoing monitoring and<br />
evaluation of the program.<br />
This overview introduces the general<br />
range of activities involved in successfully<br />
implementing EBPs. For guidelines and<br />
suggestions for EBP‐specific activities, see<br />
the remaining sections of each KIT.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 3
How to build support for your EBP<br />
Consensus-building activities are designed to build<br />
support for implementing EBPs. Here are some<br />
ways to develop them:<br />
Step 1 Identify key stakeholders or people who<br />
will be affected by the EBP. Stakeholders<br />
may include agency personnel at all<br />
levels, mental health authority staff, and<br />
consumer and family representatives.<br />
Depending on the EBP, you may also<br />
wish to build relationships <strong>with</strong> other<br />
community organizations, such as the<br />
Department of Vocational Rehabilitation,<br />
homeless shelters, food banks, police,<br />
hospitals, peer-support programs, and<br />
consumer and family groups.<br />
Step 2 Invite one potential EBP champion from<br />
each stakeholder group to participate in<br />
an EBP advisory committee. According<br />
to agencies that have successfully<br />
implemented EBPs, identifying ongoing<br />
champions and forming an advisory<br />
committee are critical activities. While at<br />
first you may feel that creating an advisory<br />
committee slows the process, any amount<br />
of time used to build stakeholder support is<br />
worth the effort.<br />
EBPs have little hope for success if the<br />
community doesn’t recognize that they are<br />
needed, affordable, worth the effort, and<br />
congruent <strong>with</strong> community values and the<br />
agency’s practice philosophy. Mental health<br />
authorities and agency administrators must<br />
convey to key stakeholders a clear vision<br />
and a commitment to implementing the<br />
EBP. By forming an advisory committee<br />
of potential champions from each<br />
stakeholder group, you will be able to<br />
broadly disseminate information in the<br />
community. After training committee<br />
members in the basic principles of the EBP,<br />
ask them to hold informational meetings<br />
or to regularly disseminate information to<br />
their stakeholder groups.<br />
Step 3 Ask for advice. Developing the advisory<br />
committee and educating its members<br />
in the EBP early in the planning process<br />
will allow you to ask committee members<br />
for their advice during all phases of the<br />
implementation process. Community<br />
members may help assess how ready<br />
the community and the agency are to<br />
implement the EBP and its activities.<br />
Once the EBP is in place, committee<br />
members can keep EBP staff informed of<br />
relevant community trends that may have<br />
an impact on providing the EBP services.<br />
EBP advisory committees are crucial<br />
for sustaining the EBP over time. When<br />
EBP staff turn over, or other well-trained<br />
staff leave and must be replaced, or when<br />
funding streams or program requirements<br />
change, community and political alliances<br />
are essential. A well-established committee<br />
can champion the EBP through changes.<br />
Step 4 Build an action plan. Once key<br />
stakeholders basically understand the EBP,<br />
have your advisory committee develop an<br />
action plan for implementation. Action<br />
plans outline activities and strategies<br />
involved in developing the EBP program,<br />
including the following:<br />
nIntegrating the EBP principles into<br />
mental health authority and agency<br />
policies and procedures;<br />
nOutlining initial and ongoing training<br />
plans for internal and external<br />
stakeholders; and<br />
4 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
nDesigning procedures to regularly<br />
monitor and evaluate the EBP.<br />
Base the activities in your action plan on<br />
the needs of the population you serve, your<br />
community, and your organization.<br />
Step 5 Involve the advisory committee in<br />
an ongoing evaluation of the EBP.<br />
Committee members can help you<br />
decide which outcomes you should target.<br />
They can help you integrate continuous<br />
quality improvements.<br />
Integrate the EBP into Policies<br />
and Procedures<br />
Examine policies and procedures<br />
Mental health authorities and agencies that have<br />
successfully implemented EBPs highlight the<br />
importance of integrating the EBP into policies and<br />
procedures. For example, you will immediately face<br />
decisions about staffing the EBP program. Mental<br />
health authorities can support the implementation<br />
To start implementing your EBP<br />
n Pinpoint key stakeholder groups that will be<br />
affected by implementing the EBP.<br />
n Identify potential champions from each group<br />
and invite them to participate in an EBP<br />
advisory committee.<br />
n Ask the committee to advise you during<br />
the process.<br />
n Build an action plan.<br />
n Outline responsibilities for committee<br />
members, such as:<br />
o Participating in EBP basic training;<br />
o Providing basic information about the EBP<br />
to their stakeholder groups;<br />
o Advising you during all phases of the<br />
implementation process; and<br />
o Participating in an ongoing evaluation<br />
of the EBP.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 5
process by integrating staffing criteria into<br />
regulations. Agency administrators should select<br />
an EBP program leader and practitioners based<br />
on mental health authority regulations and<br />
qualifications that the EBP requires. New EBP<br />
position descriptions should be integrated into<br />
the agency’s human resource policies. EBPspecific<br />
suggestions in Building Your Program<br />
will help mental health authorities and agency<br />
staff determine the appropriate mix and number<br />
of staff, define staff roles, and develop a<br />
supervision structure.<br />
Agency administrators and mental health<br />
authorities should also review administrative<br />
policies and procedures to ensure that they are<br />
compatible <strong>with</strong> EBP principles. For example,<br />
you may need to modify admission and discharge<br />
assessment, treatment planning, and servicedelivery<br />
procedures. Make sure policies and<br />
procedures include information about how to<br />
identify consumers who are most likely to benefit<br />
from the EBP and how to integrate inclusion<br />
and exclusion criteria into referral mechanisms.<br />
Integrating EBP principles into policies and<br />
procedures will build the foundation of the<br />
EBP program and will ensure that the program<br />
is sustainable. Examine policies and procedures<br />
early in the process. While most changes will occur<br />
in the planning stages, regularly monitoring and<br />
evaluating the program (see discussion below)<br />
will allow you to periodically assess the need for<br />
more changes.<br />
Identify funding issues<br />
Identifying and addressing financial barriers is<br />
critical since specific costs are associated <strong>with</strong><br />
starting new EBP programs and sustaining them.<br />
Identify short- and long-term funding mechanisms<br />
for EBP services, including federal, state, local<br />
government, and private foundation funds. You can<br />
work <strong>with</strong> your EBP advisory committee to project<br />
start up costs by identifying the following:<br />
n Time for meeting <strong>with</strong> stakeholders that is not<br />
reimbursed;<br />
n Time for staff while in training;<br />
n Staff time for strategic planning;<br />
n Travel to visit other model EBP programs; and<br />
n Costs for needed technology (cell phones and<br />
computers) or other one-time expenses accrued<br />
during the initial implementation effort.<br />
You should also identify funding mechanisms for<br />
ongoing EBP services and to support continuous<br />
quality improvement efforts, such as ongoing<br />
training, supervision, technical assistance, fidelity,<br />
and outcomes monitoring. In addition, you may<br />
need to revise rules for reimbursement that are<br />
driven by service definitions and criteria; this may<br />
require interagency meetings on the federal, state,<br />
and local levels.<br />
6 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Get these valuable resources to help implement your EBP<br />
Numerous materials are available through the U.S. Department of Health and Human Services<br />
(http://www.hhs.gov) about using Medicaid and Medicare to fund necessary services. If you are<br />
implementing EBPs, one useful resource is Using Medicaid to Support Working Age Adults <strong>with</strong> Serious<br />
Mental Illnesses in the Community: A Handbook, published by the Assistant Secretary of Planning and<br />
Evaluation, January 2005.<br />
http://aspe.hhs.gov/daltcp/reports/handbook.pdf<br />
This handbook gives you an excellent introduction to the Medicaid program, including essential features,<br />
eligibility, and coverage of mental health services, community services, and waivers. It also provides helpful<br />
information for states seeking Medicaid funding to implement the following:<br />
n Family Psychoeducation;<br />
n Assertive Community Treatment;<br />
n Illness Management and Recovery;<br />
n Integrated Treatment for Co-Occurring Disorders;<br />
n Medication Management;<br />
n <strong>Supported</strong> <strong>Employment</strong>;<br />
n Supportive Housing;<br />
n Consumer-Directed Services; and<br />
n Peer Support.<br />
Assess Training Needs<br />
One of the next steps in implementing your<br />
EBP is to develop a training plan. You may gauge<br />
the amount of training needed by assessing the<br />
readiness of your community. If a community<br />
doesn’t know about the EBP and doesn’t recognize<br />
the existing need, you may have to conduct a wide<br />
range of educational activities. If a community<br />
already understands the EBP and knows how it may<br />
address problems that community members want<br />
to solve, you may need fewer educational activities.<br />
You can help train key stakeholder groups if<br />
you first train members of your EBP advisory<br />
committee and then ask them to disseminate<br />
information about the purpose and benefits<br />
of the EBP.<br />
In addition to assessing training needs in the<br />
community, agency administrators should gauge<br />
how well staff across the agency understand the<br />
EBP. Agency administrators who have successfully<br />
implemented EBPs highlight the importance of<br />
providing basic training on the EBP to all levels<br />
of staff throughout the agency. Educating and<br />
engaging staff will ensure support for the EBP.<br />
In the long run, if they are well trained, EBP<br />
staff will have an easier time obtaining referrals,<br />
collaborating <strong>with</strong> staff from other service<br />
programs, and facilitating a continuum of care.<br />
Ongoing in-service training is an efficient way to<br />
provide background information, the EBP practice<br />
philosophy and values, and the basic rationale<br />
for EBP service components in a comfortable<br />
environment. Consider including members of<br />
your advisory committee in decisions about the<br />
frequency and content of basic EBP training.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 7
Offer more intensive training to program<br />
leaders and practitioners<br />
While staff at all levels in the agency should<br />
receive basic EBP training, the program leader and<br />
practitioners will require more intensive training.<br />
To help practitioners integrate EBP principles<br />
into their daily practice, offer comprehensive<br />
skills training to those who provide EBP services.<br />
Each KIT contains a variety of EBP-specific<br />
training tools to help you provide both basic and<br />
intensive training.<br />
Although most skills that practitioners need may<br />
be introduced through these training tools, research<br />
and experience show that the most effective way to<br />
teach EBP skills is through on-the-job consultation.<br />
Consultants may provide comprehensive training<br />
and case consultation to EBP practitioners.<br />
Consultants may also help mental health authorities<br />
and agency administrators to do the following:<br />
n Provide basic information to key stakeholders;<br />
n Assess the community’s readiness for change;<br />
n Assist in integrating EBP principles into policies<br />
and procedures; and<br />
Many agencies have also found it useful for<br />
program leaders and practitioners to become<br />
familiar <strong>with</strong> the structure and processes of the<br />
practice by visiting agencies that have successfully<br />
implemented the EBP.<br />
Early in the process, mental health authorities<br />
and agency administrators must decide how to<br />
accomplish the following:<br />
n Identify internal and external stakeholders who<br />
will receive basic training;<br />
n Determine how often basic training will be<br />
offered;<br />
n Identify who will provide the training;<br />
n Identify EBP staff and advisory group members<br />
who will receive comprehensive skills training;<br />
n Determine the training format for ongoing<br />
training to EBP staff; and<br />
n Determine whether EBP staff may visit a model<br />
EBP program.<br />
EBP-specific suggestions in Building Your Program<br />
will help mental health authorities and agency staff<br />
develop an EBP training plan.<br />
n Design ongoing training plans.<br />
In many mental health agencies, turnover of<br />
staff is high. This means that the EBP will not<br />
be sustained unless ongoing training is offered to<br />
all employees.<br />
8 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Monitor and Evaluate Regularly<br />
Key stakeholders who implement EBPs may find<br />
themselves asking two questions:<br />
n Has the EBP been implemented as planned?<br />
n Has the EBP resulted in the expected<br />
outcomes?<br />
Asking these two questions and using the answers<br />
to improve your program is a critical component<br />
for ensuring the success of your EBP.<br />
n To answer the first question, collect process<br />
measures (by using the EBP Fidelity Scale and<br />
General Organizational Index). Process measures<br />
capture how services are provided.<br />
n To answer the second question, collect outcome<br />
measures. Outcome measures capture the results<br />
or achievements of your program.<br />
As you prepare to implement an EBP, we strongly<br />
recommend that you develop a quality assurance<br />
system using both process and outcome measures<br />
to monitor and improve the program’s quality from<br />
the startup phase and continuing through the life<br />
of the program. Evaluating Your Program in the<br />
KIT contains an EBP-specific Fidelity Scale, the<br />
General Organizational Index, and sample outcome<br />
measures. These measures may be integrated<br />
into existing quality assurance programs or help<br />
agencies develop new ones.<br />
Why you should collect process measures<br />
Process measures, such as the EBP Fidelity Scale<br />
and General Organizational Index, help you assess<br />
whether the core elements of the EBP were put<br />
into place in your agency. Research tells us that<br />
the higher an agency scores on a fidelity scale, the<br />
greater the likelihood that the agency will achieve<br />
favorable outcomes (Becker et al., 2001; Bond &<br />
Salyers, 2004). For this reason, it is important to<br />
monitor both fidelity and outcomes.<br />
Process measures give agency staff an objective,<br />
structured way to determine if you are delivering<br />
services in the way that research has shown will<br />
result in desired outcomes. Collecting process<br />
measures is an excellent method to diagnose<br />
program weaknesses, while helping to clarify<br />
program strengths. Process measures also give<br />
mental health authorities a comparative framework<br />
to evaluate the quality of EBPs across the state.<br />
They allow mental health authorities to identify<br />
statewide trends and exceptions to those trends.<br />
Why you should collect outcome measures<br />
While process measures capture how services<br />
are provided, outcome measures capture the<br />
program’s results. Every service intervention has<br />
both immediate and long-term consumer goals.<br />
In addition, consumers have goals for themselves,<br />
which they hope to attain by receiving mental<br />
health services. These goals translate into outcomes<br />
and the outcomes translate into specific measures.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 9
Some outcomes directly result from an<br />
intervention, such as getting a job by participating<br />
in a supported employment program. Others are<br />
indirect, such as improving consumers’ quality of<br />
life as a result of having a job. Some outcomes are<br />
concrete and observable, such as the number of<br />
days worked in a month. Others are subjective,<br />
such as being satisfied <strong>with</strong> EBP services.<br />
Therefore, you should collect outcome<br />
measures, such as homelessness, hospitalization,<br />
incarceration, and recovery, that show the effect<br />
that services have had on consumers, in addition<br />
to the EBP fidelity measures. Monitoring fidelity<br />
and outcomes on an ongoing basis is a good<br />
way to ensure that your EBP is effective.<br />
Developing a quality assurance<br />
system will help you<br />
n Diagnose your program’s strengths<br />
and weaknesses;<br />
n Formulate action plans to improve the<br />
program;<br />
n Help consumers achieve their goals for<br />
recovery; and<br />
n Deliver mental health services both<br />
efficiently and effectively.<br />
How process and outcome data improve EBPs<br />
Collecting and using process and outcome<br />
data can improve consumer participation and<br />
staff performance.<br />
Consider the following story:<br />
Participants in a partial hospitalization program<br />
sponsored by a community mental health center<br />
consistently showed very little vocational interest or<br />
activity. Program staff began gathering data monthly<br />
about consumers’ vocational status and reporting the<br />
data to their program consultant. Every 3 months, the<br />
consultant returned the data to them using a simple<br />
bar graph.<br />
The positive result of gathering and using information<br />
about consumers’ vocational activity was evident<br />
almost immediately. Three months after starting this<br />
monitoring system, the percentage of the program’s<br />
consumers who showed an interest or activity in<br />
vocational areas increased from 36% to 66%. Three<br />
months later, 72% of program participants were<br />
involved in some form of vocational activity.<br />
This example shows that sharing process and<br />
outcomes data <strong>with</strong> consumers can stimulate<br />
participation in your EBP program.<br />
Similarly, disseminating assessment data can<br />
enhance the performance of EBP staff and increase<br />
motivation, professional learning, and a sense<br />
of accomplishment. In their study of successful<br />
companies, Peters and Waterman (1982) observed:<br />
We are struck by the importance of available<br />
information as the basis for peer comparison.<br />
Surprisingly, this is the basic control mechanism<br />
in the excellent companies. It is not the military<br />
model at all. It is not a chain of command wherein<br />
nothing happens until the boss tells somebody to<br />
do something. General objectives and values are set<br />
forward and information is shared so widely that<br />
people know quickly whether or not the job is getting<br />
done — and who’s doing it well or poorly (p. 266).<br />
Information in Evaluating Your Program will teach<br />
quality assurance team members how to collect,<br />
analyze, and use process and outcomes data to<br />
improve their EBP program.<br />
10 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Maximize Effectiveness<br />
by Making Services<br />
Culturally Competent<br />
Cultural competence is an approach to delivering<br />
services that assumes that services are more<br />
effective when they are provided <strong>with</strong>in the most<br />
relevant and meaningful cultural, gender-sensitive,<br />
and age-appropriate context for the people<br />
being served.<br />
You can improve the quality of your EBP program<br />
by ensuring that it is culturally competent — that<br />
it adapts to meet the needs of consumers from<br />
diverse cultures. First, it’s important to understand<br />
what culture and cultural competence are and how<br />
they affect care.<br />
What culture is and how it affects care<br />
Broadly defined, culture is a common heritage or<br />
set of beliefs, norms, and values that a group of<br />
people shares. People who are placed — either by<br />
census categories or by identifying themselves —<br />
into the same racial or ethnic group are often<br />
assumed to share the same culture; however, not all<br />
members who are grouped together will share the<br />
same culture.<br />
A great diversity exists <strong>with</strong>in each broad category.<br />
Some individuals may identify <strong>with</strong> a given racial<br />
or ethnic culture to varying degrees, while others<br />
may identify <strong>with</strong> multiple cultures, including those<br />
associated <strong>with</strong> their religion, profession, sexual<br />
orientation, region, or disability status.<br />
Culture is dynamic. It changes continually and<br />
is influenced both by people’s beliefs and by the<br />
demands of their environment. Immigrants from<br />
different parts of the world arrive in the United<br />
States <strong>with</strong> their own culture but gradually begin<br />
to adapt and develop new, hybrid cultures that<br />
allow them to function in the dominant culture.<br />
This process is called acculturation. Even groups<br />
that have been in the U.S. for many generations<br />
may share beliefs and practices that maintain<br />
influences from multiple cultures. This complexity<br />
necessitates an individualized approach to<br />
understanding culture and cultural identity in<br />
the context of mental health services.<br />
Culture influences many aspects of care,<br />
starting <strong>with</strong> whether people think care is<br />
even needed. Culture influences the concerns<br />
that people bring to the clinical setting, the<br />
language they use to express those concerns,<br />
and the coping styles they adopt.<br />
Culture affects family structure, living<br />
arrangements, and the degree of support that<br />
people receive in time of difficulties. Culture<br />
also influences patterns of help-seeking, whether<br />
people start <strong>with</strong> a primary care doctor, a mental<br />
health program, or a minister, spiritual advisor, or<br />
community elder. Finally, culture affects whether<br />
people attach a stigma to mental health problems<br />
and how much trust they place in the hands<br />
of providers.<br />
Culture isn’t just a consumer issue<br />
It’s easy to think that culture belongs only to<br />
consumers <strong>with</strong>out realizing how it also applies to<br />
providers and administrators. Their professional<br />
culture influences how they organize and deliver<br />
care. Some cultural influences are more obvious<br />
than others — such as the manner in which<br />
practitioners ask questions or how they interact<br />
<strong>with</strong> consumers. Less obvious but equally<br />
important are issues such as the following:<br />
n The operating hours of an agency;<br />
n The importance that staff attaches to reaching out<br />
to family members and community leaders; and<br />
n The respect that staff gives to the culture of<br />
consumers who enter their doors.<br />
Knowing how culture influences so many aspects<br />
of mental health care underscores the importance<br />
of adapting agency practices to respond to,<br />
and be respectful of, the diversity of the<br />
surrounding community.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 11
The need for cultural competence<br />
For decades, many mental health agencies<br />
neglected to recognize the growing diversity<br />
around them. Often, people from non-majority<br />
cultures found programs off-putting and hard to<br />
access. They avoided getting care, stopped looking<br />
for care, or — if they managed to find care — they<br />
dropped out.<br />
Troubling disparities resulted. Many minority<br />
groups faced lower access to care, lower use of care,<br />
and poorer quality of care. Disparities were most<br />
apparent for racial and ethnic minority groups,<br />
such as the following:<br />
n African Americans;<br />
n American Indians and Alaska Natives;<br />
n Asian Americans;<br />
n Hispanic Americans; and<br />
n Native Hawaiians and other Pacific Islanders.<br />
But disparities also affect many other groups,<br />
such as the following:<br />
n Women and men;<br />
n Children and older adults;<br />
n People from rural areas;<br />
n People of different religions;<br />
n People <strong>with</strong> different sexual orientations; and<br />
n People <strong>with</strong> physical or developmental<br />
disabilities.<br />
Altogether, those disparities meant that millions<br />
of people suffered needless disability from<br />
mental illnesses.<br />
Starting in the late 1980s, the mental health<br />
profession responded to the issue of disparity <strong>with</strong><br />
a new approach to care called cultural competence.<br />
Originally cultural competence was defined as a<br />
set of congruent behaviors, attitudes, and policies<br />
that come together in a system, agency, or among<br />
professionals to enable people to work effectively<br />
in cross-cultural situations. Cultural competence is<br />
intended to do the following:<br />
n Improve consumers’ access to care;<br />
n Build trust; and<br />
n Promote consumers’ engagement and retention<br />
in care.<br />
What is cultural competence?<br />
In the Surgeon General’s report on the topic<br />
cultural competence, it is defined in the most<br />
general terms as<br />
“… the delivery of services responsive to the cultural<br />
concerns of racial and ethnic minority groups,<br />
including their languages, histories, traditions,<br />
beliefs, and values” (U.S. Department of Health<br />
and Human Services, 2001).<br />
In most cases, cultural competence refers to sets of<br />
guiding principles developed to increase the ability<br />
of mental health providers, agencies, or systems to<br />
meet the needs of diverse communities, including<br />
racial and ethnic minorities.<br />
While consumers, families, providers, policymakers,<br />
and administrators have long acknowledged the<br />
intrinsic value of cultural competence, insufficient<br />
research has been dedicated to identifying its key<br />
ingredients. Therefore, the field still struggles to<br />
define cultural competence, put it into operation,<br />
and measure it.<br />
The word competence is somewhat misleading.<br />
It usually implies a set of criteria on which to<br />
evaluate a program. But this is not yet true;<br />
cultural competence is still underresearched.<br />
In this context, competence means that the<br />
responsibility to tailor care to different cultural<br />
groups belongs to the system, not to the consumer.<br />
Every provider or administrator who is involved<br />
in delivering care — from mental health<br />
authorities down to clinical supervisors and<br />
practitioners — bears responsibility for trying to<br />
make programs accessible, appropriate, appealing,<br />
and effective for the diverse communities<br />
that they serve. Many do it naturally.<br />
12 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
How cultural competence<br />
relates to EBPs<br />
According to the Surgeon General, evidence-based<br />
practices are intended for every consumer who<br />
enters care, regardless of his or her culture. But<br />
programs often need to adjust EBPs to make them<br />
accessible and effective for cultural groups that<br />
differ in language or behavior from the original<br />
study populations. The adjustments should help,<br />
rather than interfere <strong>with</strong>, a program’s ability to<br />
implement EBPs using the KITs.<br />
In a nutshell, to deliver culturally competent<br />
EBPs, you must tailor to the unique communities<br />
you serve either the practice itself or the context<br />
in which the practice is delivered. In time, specific<br />
fidelity measures may be available to assess a<br />
program’s cultural competence, but not yet. The<br />
evidence base of cultural competence is too small.<br />
While the evidence is being collected, programs<br />
can and should tailor EBPs to each cultural<br />
group they serve, for instance, by translating<br />
their informational brochures into the languages<br />
often used in their communities. For more<br />
suggestions, see How to put cultural competence<br />
into practice.<br />
Many providers ask,<br />
How can we know if EBPs apply to a particular<br />
ethnic, racial, or cultural group if the research<br />
supporting those practices was done on a very<br />
different population?<br />
The answer is that we will not know for sure<br />
until we try; but the limited research that<br />
does exist suggests that EBPs, perhaps <strong>with</strong><br />
minor modifications, work well across cultures.<br />
Furthermore, because EBPs represent the highest<br />
quality of care currently available, it is a matter of<br />
fairness and prudence to provide them to all people<br />
who may need them. Yet the question remains,<br />
How can we do this effectively?<br />
How to put cultural competence<br />
into practice<br />
Since the goal is for all programs to be more<br />
culturally competent, we offer a variety of<br />
straightforward steps to help agency administrators<br />
respond more effectively to the people they serve.<br />
These steps apply to all facets of a program; they<br />
are not restricted to the EBP program alone. Please<br />
note that the following guidelines are meant to be<br />
illustrative, not prescriptive:<br />
n Understand the racial, ethnic, and cultural<br />
demographics of the population served.<br />
n Become most familiar <strong>with</strong> one or two of the<br />
groups you most commonly encounter.<br />
n Create a cultural competence advisory committee<br />
consisting of consumers, family, and community<br />
organizations.<br />
n Translate your forms and brochures.<br />
n Offer to match a consumer <strong>with</strong> a practitioner<br />
who has a similar background.<br />
n Have ready access to qualified interpreters.<br />
n Ask consumers about their cultural backgrounds<br />
and identities.<br />
n Incorporate cultural awareness into consumers’<br />
assessment and treatment.<br />
n Tap into natural networks of support, such as<br />
the extended family and community groups that<br />
represent the consumer’s culture.<br />
n Reach out to religious and spiritual organizations<br />
to encourage referrals or as another network<br />
of support.<br />
n Offer training to staff in culturally responsive<br />
communication or interviewing skills.<br />
n Understand that some behaviors that one culture<br />
may consider to be signs of psychopathology are<br />
acceptable in a different culture.<br />
n Be aware that consumers from other cultures<br />
may hold different beliefs about causes and<br />
treatment of illness.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 13
How mental health authorities<br />
can help<br />
We offer you a few examples of how public<br />
mental health authorities can help develop a more<br />
culturally competent mental health system:<br />
n Designate someone <strong>with</strong> part-time or full-time<br />
responsibility for improving and monitoring<br />
cultural competence.<br />
n Create a strategic plan to incorporate cultural<br />
competence into the mental health system.<br />
n Establish an advisory committee that includes<br />
representatives from all the major racial, ethnic,<br />
and cultural groups you serve.<br />
n Address barriers to care (including cultural,<br />
linguistic, geographic, or economic barriers).<br />
n Promote staffing that reflects the composition of<br />
the community you serve.<br />
n Promote regular organizational self-assessments<br />
of cultural competence.<br />
n Collect and analyze data to examine disparities in<br />
services.<br />
n Designate specific resources for cultural<br />
competence training.<br />
n Include cultural competence in quality-assurance<br />
and quality-improvement activities.<br />
For more suggestions about adapting EBPs to<br />
diverse groups, see the remaining booklets in<br />
the KIT.<br />
A look at cultural competence<br />
through five vignettes<br />
Vignette — Integrated Treatment for<br />
Co‐Occurring Disorders<br />
Kevin is a 40-year-old African American homeless<br />
man in Chicago who, for a decade, cycled between<br />
jail, street, and shelter. At the shelter, he refused<br />
help for what the staff believed was a longstanding<br />
combination of untreated schizophrenia and<br />
alcoholism.<br />
He became so drunk one night that he walked in<br />
front of a car and was seriously injured. While in the<br />
hospital, he was treated for his injuries, as well as<br />
placed on anti-psychotic medications after psychiatrists<br />
diagnosed him <strong>with</strong> schizophrenia.<br />
When he was discharged from the hospital, Kevin<br />
was referred to an integrated treatment program<br />
for co-occurring disorders. Realizing that Kevin<br />
needed aggressive treatment to avoid spiraling into<br />
homelessness again, the head of the treatment team<br />
recommended concurrently treating the alcoholism<br />
and schizophrenia. The integrated treatment<br />
specialist was an African American psychiatrist who<br />
appreciated the years of alienation, discrimination,<br />
and victimization that Kevin described as having<br />
contributed to his co-occurring disorders.<br />
The integrated treatment specialist worked hard to<br />
develop a trusting relationship. He worked <strong>with</strong> the<br />
treatment team to ensure that, in addition to mental<br />
health and substance abuse treatment, Kevin received<br />
social skills training and a safe place to live. When<br />
Kevin was well enough, and while he continued<br />
receiving group counseling for his co-occurring<br />
disorders, one of his first steps toward recovery was to<br />
reconnect <strong>with</strong> his elderly mother who had not heard<br />
from him in 10 years.<br />
14 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Vignette — Assertive Community Treatment<br />
A minister in Baltimore contacted the city’s Assertive<br />
Community Treatment (ACT) program <strong>with</strong> an unusual<br />
concern: one of his congregants disclosed to him<br />
that another member of the congregation — an<br />
older woman from Jamaica — was beating her adult<br />
daughter for “acting crazy all the time.” The Jamaican<br />
mother might even be locking her adult daughter in<br />
the basement, according to the congregant.<br />
One year before, an ACT team member had reached<br />
out to local ministers to tell them about the program.<br />
The ACT team had realized that better communication<br />
and referrals were needed. Stronger connections<br />
across organizations would improve chances for<br />
recovery by enhancing social support and adherence<br />
to treatment. Some consumers, however, believed that<br />
treatment was against their religion.<br />
The ACT team member obtained a court order to<br />
allow authorities to enter the Jamaican mother’s<br />
home. They discovered the traumatized 25-year-old<br />
daughter locked in the basement, actively psychotic,<br />
and bearing marks of physical abuse. The team<br />
diagnosed the daughter <strong>with</strong> schizophrenia and<br />
arranged suitable housing for her.<br />
The team arranged for an intense combination<br />
of medications and individual and group therapy,<br />
including trauma care and social skills training.<br />
Through links to the church and the community,<br />
the team helped the daughter get clothing and<br />
spiritual support.<br />
The team discovered that the mother’s ethnic<br />
group from Jamaica believed that her daughter’s<br />
mental illness was a sign of possession by the devil.<br />
The team reached out to the mother to educate her<br />
about schizophrenia and to set the stage for the<br />
daughter’s eventual return to her mother’s household.<br />
Vignette — Illness Management and Recovery<br />
Lupita, a 17-year-old high school senior, arrived in<br />
an emergency room after a suicide attempt. The<br />
psychiatrist on call happened to be the same one who<br />
had diagnosed Lupita’s bipolar disorder a year before.<br />
He thought that she had been taking her medications<br />
properly, but blood tests now revealed no trace of<br />
psychiatric medication.<br />
The psychiatrist tried to communicate <strong>with</strong> Lupita’s<br />
anxious parents who were waiting in the visitor<br />
area, only to learn that they spoke only Spanish,<br />
not English. The psychiatrist had mistakenly assumed<br />
that because Lupita, a second-generation Mexican<br />
American, was highly acculturated, so were her<br />
parents. She contacted the hospital’s bilingual Illness<br />
Management and Recovery (IMR) practitioner who<br />
learned that the parents felt powerless for months<br />
as they watched their daughter sink into a severe<br />
depression, as she was not taking her medications.<br />
The IMR practitioner, whose family had similarly<br />
emigrated from a rural region of Mexico, knew<br />
to gently ask the parents if they could read and<br />
understand the dosage directions for Lupita’s<br />
medication. Finding that the parents had limited<br />
literacy in both English and Spanish, they tailored the<br />
treatment program so that it would not depend on<br />
the written word. They also introduced Lupita and<br />
her family to the IMR program. The hospital had<br />
organized programs for Spanish-speaking families<br />
because of the large number of Latinos in the area.<br />
During the weekly sessions, the IMR practitioner<br />
translated for the family and helped them schedule<br />
Lupita’s psychiatric visits. Together they apportioned<br />
the correct combination of pills in a daily pill<br />
container. Understanding that the family had no<br />
phone, the IMR practitioner worked <strong>with</strong> them to find<br />
a close neighbor who might allow them to use the<br />
phone to relay messages from her and to contact her<br />
if Lupita stopped taking her medications.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 15
Vignette — Family Psychoeducation<br />
In times of difficulties, many Native Hawaiians rely on<br />
their elders, traditional healers, families, or teachers<br />
to provide them <strong>with</strong> wisdom and cultural practices to<br />
resolve problems. One such practice is ho`oponopono,<br />
which is a traditional cultural process for maintaining<br />
harmonious relationships among families through<br />
a structured discussion of conflicts. Ho`oponopono<br />
is also used by people for personal healing and<br />
guidance in troubled times.<br />
When Kawelo lost his job as an electrician, his mental<br />
health practitioner asked him if he had a family elder<br />
who knew of community elders who were familiar<br />
<strong>with</strong> traditional Hawaiian healing practices. Kawelo’s<br />
practitioner recognized the importance of tapping into<br />
this community support and suggested that his family<br />
seek out ho`oponopono.<br />
Kawelo and his practitioner contacted the family and<br />
elders to arrange a meeting. At the meeting, the<br />
practitioner provided information about Kawelo’s<br />
illness. They discussed symptoms and warning signs<br />
of relapse.<br />
The therapist asked the elders how the group could<br />
support Kawelo’s recovery. After lengthy deliberations,<br />
the family decided that one way to help Kawelo was to<br />
participate in ho’oponopono to understand the types<br />
of problems that he was experiencing and identify<br />
how the family could help him heal himself. Some<br />
members of the family also agreed to participate in<br />
a Family Psychoeducation (FPE) program to learn<br />
more about his mental illness and ways to support<br />
his recovery.<br />
Vignette — <strong>Supported</strong> <strong>Employment</strong><br />
Jing is a bilingual employment specialist. By<br />
informally surveying her caseload, she estimates<br />
that about 30% of the consumers <strong>with</strong> whom she<br />
works are Asian, but they come from vastly different<br />
backgrounds, ranging from Taiwan to Cambodia, <strong>with</strong><br />
different educational levels.<br />
One of the consumers <strong>with</strong> bipolar disorder <strong>with</strong><br />
whom she works recently immigrated from China. He<br />
has a high school education, but speaks Mandarin and<br />
very little English. Fluent in Mandarin, Jing is able to<br />
conduct a careful assessment of the consumer’s job<br />
skills and a rapid, individualized job search.<br />
Jing identifies several import-export businesses in<br />
the area that have monolingual Mandarin-speaking<br />
employees. She and the consumer secure a position,<br />
but it pays less than one the consumer would qualify<br />
for if he spoke English. Jing and the consumer<br />
decide to take the position while, at the same time,<br />
participating in a quick-immersion night program in<br />
English as a Second Language.<br />
Jing provides follow-along job support during the next<br />
few months. When the consumer’s English is better,<br />
Jing and the consumer search for and find a higher<br />
paying job. Jing continues follow-along services to<br />
support the consumer in his adjustment to the greater<br />
demands of the new position.<br />
Through the FPE program, the family participated in<br />
structured multi-family group sessions. Because an<br />
important level of healing in Native Hawaiian culture<br />
involves sharing positive and negative emotions in an<br />
open, safe, and controlled environment, the family’s<br />
participation in a combination of ho’oponopono<br />
and FPE was successful in helping Kawelo.<br />
16 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Selected resources on cultural competence<br />
The following resources on cultural competences<br />
apply to all EBPs. These resources are for<br />
consumers and families, mental health authorities,<br />
administrators, program leaders, and practitioners.<br />
For resources related to each EBP, see The<br />
Evidence in each KIT.<br />
National resources for consumers<br />
and families<br />
Center for Mental Health Services<br />
Substance Abuse and Mental Health Services<br />
Administration<br />
<strong>SAMHSA</strong>’s Health Information Network<br />
Rockville, MD 20857<br />
Phone: (877) <strong>SAMHSA</strong>-7 (1-877-726-4727)<br />
(English and Español)<br />
www.samhsa.gov/shin<br />
First Nations Behavioral Health Confederacy<br />
Phone: (406) 732-4240 Montana<br />
Phone: (505) 275-3801 Albuquerque, NM<br />
pauletterunningwolf@hotmail.com<br />
National Alliance on Mental Illness (NAMI)<br />
Colonial Place Three<br />
2107 Wilson Boulevard, Suite 300<br />
Arlington, VA 22201-3042<br />
Phone: (800) 950-NAMI (6264)<br />
Fax: (703) 524-9094<br />
TTY: (703) 516-7227<br />
www.nami.org<br />
National Institute of Mental Health (NIMH)<br />
Office of Communications<br />
6001 Executive Boulevard<br />
Room 8184, MSC 9663<br />
Bethesda, MD 20892-9663<br />
Phone: (866) 615-NIMH (6464)<br />
Fax: (301) 443-4279<br />
TTY: (301) 443-8431<br />
www.nimh.nih.gov<br />
National Latino Behavioral Health Association<br />
P.O. Box 387<br />
506 Welch, Unit B<br />
Berthoud, CO 80513<br />
Phone: (970) 532-7210<br />
Fax: (970) 532-7209<br />
www.nlbha.org<br />
National Leadership Council on African American<br />
Behavioral Health<br />
6904 Tulane Drive<br />
Austin, TX 78723-2823<br />
Phone: (512) 929-0142<br />
Fax: (512) 471-9600<br />
tkjohnson@mail.utexas.edu<br />
Mental Health America<br />
2001 North Beauregard Street, 6th Floor<br />
Alexandria, VA 22311<br />
Phone: (800) 969-6642<br />
Phone: (703) 684-7722<br />
Fax: (703) 684-5968<br />
TDD: (800) 433-5959<br />
www.nmha.org<br />
National Asian American Pacific Islander<br />
Mental Health Association<br />
1215 19th Street, Suite A<br />
Denver, CO 80202<br />
Phone: (303) 298-7910<br />
Fax: (303) 298-8081<br />
www.naapimha.org<br />
Resources for mental health authorities<br />
Aponte, C., & Mason, J. (1996). A demonstration<br />
project of cultural competence self-assessment<br />
of 26 agencies. In M. Roizner, A practical<br />
guide for the assessment of cultural competence<br />
in children’s mental health organizations<br />
(pp. 72–73). Boston: Judge Baker<br />
Children’s Center.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 17
California Mental Health Ethnic Services<br />
Managers <strong>with</strong> the Managed Care Committee.<br />
(1995). Cultural competency goals, strategies<br />
and standards for minority health care to<br />
ethnic clients. Sacramento: CA: Mental Health<br />
Directors’ Association.<br />
Carpinello, S. E., Rosenberg, L., Stone, J.,<br />
Schwager, M., and Felton, C. J. (2002). Best<br />
practices: New York State’s campaign to<br />
implement evidence-based practices for people<br />
<strong>with</strong> serious mental disorders. Psychiatric<br />
Services, 53(2), 153–5.<br />
Chorpita, B. F., & Nakamura, B. J. (2004). Four<br />
considerations for dissemination of intervention<br />
innovations. Clinical Psychology: Science and<br />
Practice, 11, 364–367.<br />
Dillenberg, J., & Carbone, C. P. (1995). Cultural<br />
competency in the administration and delivery of<br />
behavioral health services. Phoenix, AZ: Arizona<br />
Department of Health Services.<br />
Knisley, M. B. (1990). Culturally sensitive language:<br />
community certification standards. Columbus,<br />
OH: Ohio Department of Mental Health.<br />
National Implementation Research Network.<br />
(2003). Consensus statement on evidence-based<br />
programs and cultural competence. Tampa, FL:<br />
Louis de la Parte Florida Mental Health Institute.<br />
New York State Office of Mental Health. (1998).<br />
Cultural competence performance measures for<br />
managed behavioral healthcare programs. Albany,<br />
NY: New York State Office of Mental Health.<br />
New York State Office of Mental Health.<br />
(1998). Final Report: Cultural and Linguistic<br />
Competency Standards. Albany, NY: New York<br />
State Office of Mental Health.<br />
Pettigrew, G. M. (1997). Plan for culturally<br />
competent specialty mental health services.<br />
Sacramento, CA: California Mental Health<br />
Planning Council.<br />
Phillips, D., Leff, H. S., Kaniasty, E., Carter,<br />
M., Paret, M., Conley, T., & Sharma, M.<br />
(1999). Culture, race and ethnicity (C/R/E)<br />
in performance measurement: A compendium<br />
of resources; Version 1. Cambridge, MA: The<br />
Human Services Research Institute (Evaluation<br />
Center@HSRI).<br />
Siegel, C., Davis-Chambers, E., Haugland, G.,<br />
Bank, R., Aponte, C., & McCombs, H. (2000).<br />
Performance measures of cultural competency in<br />
mental health organizations. Administration and<br />
Policy in Mental Health, 28, 91–106.<br />
U.S. Department of Health and Human Services.<br />
(1996). Consumer mental health report card.<br />
Final report: task force on a consumer-oriented<br />
mental health report card. Rockville, MD:<br />
Substance Abuse and Mental Health Services<br />
Administration.<br />
U.S. Department of Health and Human Services.<br />
(2000). Cultural competence standards in<br />
managed mental health care services: Four<br />
underserved/underrepresented racial/ethnic<br />
groups. HHS Pub. No. SMA 00-3457. Rockville,<br />
MD: Center for Mental Health Services,<br />
Substance Abuse and Mental Health Services<br />
Administration.<br />
U.S. Department of Health and Human Services.<br />
(1999). Mental health: A report of the Surgeon<br />
General. Rockville, MD: U.S. Department of<br />
Health and Human Services, Substance Abuse<br />
and Mental Services Administration, Center for<br />
Mental Health Services, National Institutes of<br />
Health, National Institute of Mental Health.<br />
Western Interstate Commission for Higher<br />
Education (WICHE) and Human Services<br />
Research Institute (The Evaluation Center@<br />
HSRI). (1999). Notes from a roundtable<br />
on conceptualizing and measuring cultural<br />
competence. Boulder, CO: WICHE, Publications.<br />
18 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Western Interstate Commission for Higher<br />
Education (WICHE). (1997). Cultural<br />
competence standards in managed mental health<br />
care for four underserved/ under represented<br />
racial/ethnic groups. Boulder, CO: WICHE<br />
Publications.<br />
Center for Mental Health Services<br />
Substance Abuse and Mental Health Services<br />
Administration<br />
<strong>SAMHSA</strong>’s Health Information Network<br />
Rockville, MD 20857<br />
Phone: (877) <strong>SAMHSA</strong>-7 (1-877-726-4727)<br />
(English and Español)<br />
www.samhsa.gov/shin<br />
Hogg Foundation for Mental Health<br />
The University of Texas at Austin<br />
P.O. Box 7998<br />
Austin, TX 78713-7998<br />
Phone: (800) 404-4336<br />
Fax: (512) 471-5041<br />
http://www.hogg.utexas.edu<br />
Resources for mental health administrators<br />
Lopez, L., Jackson, V. H. (1999). Cultural<br />
competency in managed behavioral healthcare:<br />
An overview. In V. H. Jackson, L. Lopez<br />
(Eds.). Cultural competency in managed<br />
behavioral healthcare. Providence, RI: Manisses<br />
Communications Group, Inc.<br />
Center for Mental Health Services<br />
Substance Abuse and Mental Health Services<br />
Administration<br />
<strong>SAMHSA</strong>’s Health Information Network<br />
Rockville, MD 20857<br />
Phone: (877) <strong>SAMHSA</strong>-7 (1-877-726-4727)<br />
(English and Español)<br />
www.samhsa.gov/shin<br />
Human Services Research Institute<br />
2336 Massachusetts Avenue<br />
Cambridge, MA 02140<br />
Phone: (617) 876-0426<br />
www.hsri.org<br />
National Alliance of Multi-Ethnic Behavioral<br />
Health Associations<br />
1875 I Street, NW<br />
Suite 5009<br />
Washington, DC 20006<br />
Phone: (202) 429-5520<br />
www.nambha.org<br />
National Center for Cultural Competence<br />
Georgetown University Center for Child and<br />
Human Development<br />
3300 Whitehaven Street, NW<br />
Suite 3300<br />
Washington, DC 20057<br />
Phone: (202) 687-5387<br />
TTY: (202) 687-5503<br />
Western Interstate Commission for<br />
Higher Education (WICHE)<br />
Mental Health Program<br />
P.O. Box 9752<br />
Boulder, CO 80301-9752<br />
www.wiche.edu<br />
Resources for program leaders<br />
Barrio, C. (2000). The cultural relevance of<br />
community support programs. Psychiatric<br />
Services, 51, 879–874.<br />
Issacs, M. R., & Benjamin, M. P. (1991). Toward<br />
a culturally competent system of care: programs<br />
which utilize culturally competent principles.<br />
Washington, DC: Georgetown University Child<br />
Development Center.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 19
Leong, F. (1998). Delivering and evaluating mental<br />
health services for Asian Americans. In Report of<br />
the roundtable on multicultural issues in mental<br />
health services evaluation. Tucson, AZ: Human<br />
Services Research Institute (The Evaluation<br />
Center,@HSRI).<br />
Musser-Granski, J., & Carrillo, D. F. (1997). The<br />
use of bilingual, bicultural paraprofessionals in<br />
mental health services: issues for hiring, training,<br />
and supervision. Community Mental Health<br />
Journal 33, 51–60.<br />
Phillips, D., Leff, H. S., Kaniasty, E., Carter,<br />
M., Paret, M., Conley, T., & Sharma, M.<br />
(1999). Culture, race and ethnicity (C/R/E) in<br />
performance measurement: A compendium<br />
of resources; Version 1. Cambridge, MA: Human<br />
Services Research Institute (The Evaluation<br />
Center@HSRI).<br />
Ponterotto, J. G., & Alexander, C. M. (1996).<br />
Assessing the multicultural competence of<br />
counselors and clinicians. In L. A. Suzuki,<br />
P. J. Meller, J. G. Ponterotto (Eds.) Handbook of<br />
multicultural assessment: clinical, psychological,<br />
and educational applications (pp. 651–672). San<br />
Francisco: Jossey-Bass.<br />
Tirado, M. D. (1996). Tools for monitoring cultural<br />
competence in health care. San Francisco: Latino<br />
Coalition for a Healthy California.<br />
U.S. Department of Health and Human Services.<br />
(1999). Mental health: A Report of the Surgeon<br />
General. Rockville, MD: U.S. Department of<br />
Health and Human Services, Substance Abuse<br />
and Mental Health Services Administration,<br />
Center for Mental Health Services, National<br />
Institutes of Health, National Institute of<br />
Mental Health.<br />
U.S. Department of Health and Human Services.<br />
(2001). Mental health: Culture, race, and<br />
ethnicity. A supplement to mental health: A<br />
report of the Surgeon General. Rockville, MD:<br />
U.S. Department of Health and Human Services,<br />
Substance Abuse and Mental Health Services<br />
Administration, Center for Mental Health<br />
Services.<br />
Instruments to assess cultural competence<br />
Consolidated Culturalogical Assessment<br />
Toolkit (C-CAT)<br />
Ohio Department of Mental Health, 2003.<br />
n Measures cultural competence in mental health<br />
systems and organizations<br />
n Includes comprehensive training and<br />
promotional materials<br />
For more information:<br />
http://www.ccattoolkit.org/C-CAT.shtml<br />
Multiethnic Advocates for Cultural Competence<br />
Columbus, OH 43215<br />
Phone: (614) 221-7841<br />
www.maccinc.net<br />
Cross-Cultural Counseling Inventory (CCCI)<br />
n Measures knowledge, attitudes, and beliefs<br />
about cultural diversity<br />
n Measures cross-cultural counseling skills<br />
For more information:<br />
LaFromboise, T., Coleman, H., Hernandez, A.<br />
(1991). Development and factor structure of<br />
the cross-cultural counseling inventory-revised.<br />
Professional Psychology, Research and Practice<br />
22 (5), 380–388.<br />
20 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
Cultural Acceptability of Treatment Survey (CATS)<br />
Human Services Research Institute (HSRI), 1998.<br />
n Measures the cultural competency of services<br />
n Measures organizational accommodations<br />
and practices<br />
n Measures consumer preferences and satisfaction<br />
For more information:<br />
Human Services Research Institute<br />
2336 Massachusetts Avenue<br />
Cambridge, MA 02140<br />
Phone: (617) 876-0426<br />
Fax: (617) 492-7401<br />
www.hsri.org<br />
Cultural Competency Assessment Scale (CCAS)<br />
Nathan S. Kline Institute for Psychiatric<br />
Research, 2000.<br />
n Assesses organization’s level of cultural<br />
competence<br />
n Consistent <strong>with</strong> EBP fidelity instruments<br />
For more information:<br />
Nathan S. Kline Institute for Psychiatric Research<br />
140 Old Orangeburg Road<br />
Orangeburg, NY 10962<br />
Phone: (845) 398-5500<br />
Fax: (845) 398-5510<br />
http://www.rfmh.org/nki/<br />
Multicultural Counseling Awareness Scale (MCAS)<br />
n Assesses cultural awareness, knowledge,<br />
and skills<br />
n Self-report of 45 items<br />
For more information:<br />
Ponterotto, J. G., Alexander, C. M. (1996)<br />
Assessing the multicultural competence of<br />
counselors and clinicians in L. A. Suzuki,<br />
P. J. Meller, J. G. Ponterotto (Eds.) Handbook of<br />
multicultural assessment: Clinical, psychological,<br />
and educational applications (pp. 651–672) San<br />
Francisco: Jossey-Bass.<br />
Multicultural Counseling Inventory (MCI)<br />
n Assesses awareness, knowledge, skills,<br />
and relations<br />
n Self-report of 43 items<br />
For more information:<br />
Sodowsky, G. R., Taffe, R. C., Gutkin, T. B.,<br />
Wise, S. L. (1994). Development of the<br />
multicultural counseling inventory: a selfreport<br />
measure of multicultural competencies.<br />
Journal of Counseling Psychology 41, 137–148.<br />
Resources for practitioners<br />
Aguirre-Molina M., Molina C. W., & Zambrana<br />
R. E. (Eds.) (2001). Health issues in the Latino<br />
community. San Francisco, CA: John Wiley &<br />
Sons, Inc.<br />
Alvidrez, J. (1999). Ethnic variations in mental<br />
health attitudes and service among low-income<br />
African American, Latina, and European<br />
American young women. Community Mental<br />
Health Journal, 35, 515–530.<br />
American Psychiatric Association. (2000). Appendix<br />
I: Outline for cultural formulation and glossary<br />
of culture-bound syndromes. In Diagnostic<br />
and statistical manual of mental disorders,<br />
Fourth Edition, Text Revision (DSM-IV-TR).<br />
Washington, DC: Author.<br />
Aranda, M. P. (1990). Culture friendly services for<br />
Latino elders. Generations 14, 55–57.<br />
Atkinson, D. R., Morten, G., & Sue, D. (1983).<br />
Counseling American minorities. Dubuque, IA:<br />
Wm. C. Brown.<br />
Atkinson, D. R., & Gim, R. H. (1989). Asian-<br />
American cultural identity and attitudes toward<br />
mental health services. Journal of Counseling<br />
Psychology, 36, 209–213.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 21
Baldwin, J. A., & Bell, Y. (1985). The African Self-<br />
Consciousness Scale: An Afrocentric personality<br />
questionnaire. The Western Journal of Black<br />
Studies 9, 61–68.<br />
Bauer, H., Rodriguez, M. A., Quiroga, S.,<br />
Szkupinkski, S., & Flores-Ortiz, Y. G. (2000).<br />
Barriers to health care for abused Latina and<br />
Asian immigrants. Journal of Health Care for the<br />
Poor and Underserved, 11, 33–44.<br />
Belgrave, F. Z. (1998). Psychosocial aspects of<br />
chronic illness and disability among African<br />
Americans. Westport, CT: Auburn House/<br />
Greenwood Publishing Group, Inc.<br />
Berkanovic, E. (1980). The effect of inadequate<br />
language translation on Hispanics’ responses to<br />
health surveys. American Journal of Public Health<br />
70, 1273–1276.<br />
Bichsel, R. J. (1998). Native American clients’<br />
preferences in choosing counselors. Dissertation<br />
Abstracts International: Section B: Science and<br />
Engineering, 58, 3916.<br />
Branch C. & Fraser, I. (2000). Can cultural<br />
competency reduce racial and ethnic health<br />
disparities? A review and conceptual model.<br />
Medical Care Research Review, (Suppl. 1),<br />
181–217.<br />
Browne, C. T. (1986). An anguished relationship:<br />
The white institutionalized client and the<br />
non-white paraprofessional worker. Journal<br />
of Gerontological Social Work Special Issue:<br />
Ethnicity and Gerontological Social Work, 9,<br />
3–12.<br />
Bull Bear, M., & Flaherty, M. J. (1997). The<br />
continuing journey of Native American people<br />
<strong>with</strong> serious mental illness: Building hope.<br />
Boulder, CO: WICHE Publications.<br />
Carter, R. T., & Qureshi, A. (1995). A typology<br />
of philosophical assumptions in multicultural<br />
counseling and training. In J. G. Ponterotto, J.<br />
M. Casas, C. M. Alexander (Eds.) Handbook of<br />
multicultural counseling (pp. 239–262).<br />
Thousand Oaks, CA: Sage Publications.<br />
The Chinese Culture Connection. (1987). Chinese<br />
values and the search for culture-free dimensions<br />
of culture. Journal of Cross-Cultural Psychology<br />
18, 143–164.<br />
Cross, T. L., Bazron, B. J., Dennis, K. W., & Issacs,<br />
M. R. (1989). Toward a culturally competent<br />
system of care. Washington, DC: Georgetown<br />
University Child Development Center.<br />
Cuellar, I., Harris, C., & Jasso, R. (1980). An<br />
acculturation scale for Mexican-American normal<br />
and clinical populations. Hispanic Journal of<br />
Behavioral Sciences, 2, 199–217.<br />
Dana, R. H. (1998). Understanding cultural<br />
identity in intervention and assessment.<br />
Thousand Oaks, CA: Sage Publication, Inc.<br />
Davies, J., McCrae, B. P., Frank, J., Dochnahl,<br />
A., Pickering, T., Harrison, B. et al. (1983).<br />
The influence of client-clinician demographic<br />
match on client treatment outcomes. Journal of<br />
Psychiatric Treatment and Evaluation, 5, 45–53.<br />
Feliz-Ortiz, M., Newcomb, M. D., & Meyers, H.<br />
(1994). A multidimensional measure of cultural<br />
identity for Latino and Latina adolescents.<br />
Hispanic Journal of Behavioral Sciences, 16,<br />
99–115.<br />
Gallimore, R. (1998). Accommodating cultural<br />
differences and commonalities in research<br />
and practice. In Report of the roundtable on<br />
multicultural issues in mental health services<br />
evaluation. Cambridge, MA: Human Services<br />
Research Institute. (The Evaluation Center@<br />
HSRI).<br />
Gaw, A. C. (Ed.) (1993). Culture, ethnicity, and<br />
mental illness. Washington, DC: American<br />
Psychiatric Press.<br />
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Gaw, A. C. (Ed.) (2001). Concise guide to crosscultural<br />
psychiatry. Washington, DC: American<br />
Psychiatric Press.<br />
Gilvarry, C. M., Walsh, E., Samele, C., Hutchinson,<br />
G., Mallett, R., Rabe-Hesketh, S. et al. (1999).<br />
Life events, ethnicity and perceptions of<br />
discrimination in patients <strong>with</strong> mental illness.<br />
Social Psychiatry and Psychiatric Epidemiology,<br />
34, 600–608.<br />
Gopaul-McNicol, S. A., & Brice-Baker, J. (1998).<br />
Cross-cultural practice: assessment, treatment and<br />
training. New York, NY: John Wiley & Sons, Inc.<br />
Healy, C. D. (1998). African Americans’<br />
perceptions of psychotherapy: analysis of<br />
barriers to utilization. Dissertation Abstracts<br />
International: Section B: Science and<br />
Engineering, 58(9-B), 5121.<br />
Helms, J. E. (Ed.) (1990). Black and white racial<br />
identity: Theory, research, and practice. New<br />
York: Greenwood Press.<br />
Hernandez, N. E. (1999). The relationship between<br />
ethnic matching and non-matching of Black,<br />
Hispanic, and White clinicians and clients and<br />
diagnostic and treatment decisions. Dissertation<br />
Abstracts International: Section A: Humanities<br />
and Social Sciences, 60, 550.<br />
Herrera J., Lawson, W., & Sramek, J. (1999). Cross<br />
cultural psychiatry. West Sussex: John Wiley<br />
Sons, Ltd., U.K.<br />
Hinkle, J. S. (1994). Practitioners and cross-cultural<br />
assessment: a practical guide to information<br />
and training. Measurement and Evaluation in<br />
Counseling and Development Special Issue:<br />
Multicultural Assessment, 27, 103–115.<br />
Jenkins, J. H. (1992). Too close for comfort:<br />
schizophrenia and emotional over involvement<br />
among Mexican families. In A. D. Gaines, (Ed.)<br />
Ethnopsychiatry: the cultural construction of<br />
professional and folk psychiatries (pp. 203–221).<br />
Albany, NY: SUNY Press.<br />
Kohn, L. P., Oden, T., Munoz, R. F., Robinson,<br />
A., & Leavitt, D. (2002). Adapted cognitive<br />
behavioral group therapy for depressed lowincome<br />
African American women. Community<br />
Mental Health Journal, 38(6), 497–504.<br />
Lefley, H. (1990). Culture and chronic illness.<br />
Hospital and Community Psychiatry, 41, 277–286.<br />
Lewis, R. (1996). Culture and DSM-IV: diagnosis,<br />
knowledge and power. Culture, Medicine and<br />
Psychiatry, 20, 133–144.<br />
Lin, T., & Lin, M. (1978). Service delivery issues in<br />
Asian-North American communities. American<br />
Journal of Psychiatry, 135, 454–456.<br />
Lopez, S. (1997). Cultural competence in<br />
psychotherapy: a guide for clinicians and their<br />
supervisors. In C. E. Watkins, Jr. (Ed.) Handbook<br />
of psychotherapy supervision (pp. 570–588). New<br />
York: John Wiley & Sons, Inc.<br />
Marin, G., Sabogal, F., Van Oss Marin, B.,<br />
Otero-Sabogl, R., & Perez-Stable, E. (1987).<br />
Development of a short acculturation scale<br />
for Hispanics. Hispanic Journal of Behavioral<br />
Sciences 9, 183–205.<br />
Melzzich, J., Kleinman, A., Fabrega, H., & Parron,<br />
D. (Eds.) (1996). Culture and psychiatric<br />
diagnosis: A DSM-IV perspective. Washington,<br />
DC: American Psychiatric Press.<br />
Miranda, J., Chung, J. Y., Green, B. L., Krupnick,<br />
J., Siddique, J., Revicki, D. A., & Belin, T. (2003).<br />
Treating depression in predominantly lowincome<br />
young minority women: A randomized<br />
controlled trial. Journal of the American Medical<br />
Association, 290(1), 57–65.<br />
Nader, K., Dubrow, N., Stamm, B., & Hudnall, B.<br />
(1999). Honoring differences: Cultural issues in<br />
the treatment of trauma and loss. Philadelphia,<br />
PA: Brunner/Mazel, Inc.<br />
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Opaku, S. A. (Ed.) (2001). Clinical methods in<br />
transcultural psychiatry. Washington, DC:<br />
American Psychiatric Press.<br />
Parker, R., Williams, M., Weiss, B. (1999). Health<br />
Literacy: Report of the Council on Scientific<br />
Affairs. Journal of the American Medical<br />
Association, 281, 552–557.<br />
Phinney, J. (1992). The multigroup ethnic identity<br />
measure: a new scale for use <strong>with</strong> adolescents<br />
and young adults from diverse groups. Journal of<br />
Adolescent Research, 7, 156–176.<br />
Phinney, J. S. (1990). Ethnic identity in adolescents<br />
and adults: review of research. Psychological<br />
Bulletin, 108, 459–514.<br />
Pina, A. A., Silverman, W. K., Fuentes, R. M.,<br />
Kurtines, W. M., & Weems, C. F. (2003).<br />
Exposure-based cognitive-behavioral treatment<br />
for phobic and anxiety disorders: Treatment<br />
effects and maintenance for Hispanic/Latino<br />
relative to European-American youths. Journal<br />
of the American Academy of Child & Adolescent<br />
Psychiatry, 42(10), 1179–1187.<br />
Ponterotto, J. G. et al. (1996). Development and<br />
initial validation of the multicultural counseling<br />
awareness scale. In G. R. Sodowsky & J.<br />
C. Impara (Eds.) Multicultural assessment<br />
in counseling and clinical psychology<br />
(pp. 247–282). Lincoln, NE: Buros Institute<br />
of Mental Measurements.<br />
Ponterotto, J. G., Casas, J. M., & Alexander,<br />
C. M. (Eds.) (1995). Handbook of multicultural<br />
counseling. Thousand Oaks, CA: Sage<br />
Publications.<br />
Rossello, J., & Bernal, G. (1999). The efficacy of<br />
cognitive-behavioral and interpersonal treatments<br />
for depression in Puerto Rican adolescents.<br />
Journal of Consulting and Clinical Psychology,<br />
67(5), 734–745.<br />
Saldana, D. H. (1994). Acculturative stress:<br />
minority status and distress. Hispanic Journal of<br />
Behavioral Sciences, 16, 116–128.<br />
Saldana, D. H., Dassori, A. M., & Miller, A. L.<br />
(1999). When is caregiving a burden? Listening<br />
to Mexican American women. Hispanic Journal<br />
of Behavioral Sciences, 21, 283–301.<br />
Samaan, R. A. (2000). The Influences of race,<br />
ethnicity and poverty on the mental health of<br />
children. Journal of Health Care for the Poor and<br />
Underserved, 11, 100–110.<br />
Sanchez, A. M., & McGuirk, F. D. (1994). The<br />
journey of Native American people <strong>with</strong> serious<br />
mental illness: Building hope. Boulder, CO:<br />
WICHE Publications.<br />
Sandhu, D. S., Portes, P. R., & McPhee, S.<br />
A. (1996). Assessing cultural adaptation:<br />
Psychometric properties of the cultural<br />
adaptation pain scale. Journal of Multicultural<br />
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of American diversity. Walnut Creek:<br />
AltaMira Press.<br />
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63, 285–290.<br />
Sodowsky, G. R., Taffe, R. C., Gutkin, T. B.,<br />
& Wise, S. L. (1994). Development of the<br />
multicultural counseling inventory: a self-report<br />
measure of multicultural competencies. Journal<br />
of Counseling Psychology, 41, 137–148.<br />
Straussner. (Ed.) (2001). Ethnocultural factors in<br />
substance abuse treatment. New York, NY: The<br />
Guilford Press.<br />
Strickland, W. J., & Strickland, D. L. (1996).<br />
Partnership building <strong>with</strong> special populations.<br />
Family and Community Mental Health, 19,<br />
21–34.<br />
Sue, S. (1981). Programmatic issues in the training<br />
of Asian-American psychologists. Journal of<br />
Community Psychology, 9, 293–297.<br />
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Sue, S. (1998). In search of cultural competence<br />
in psychotherapy and counseling. American<br />
Psychologist, 53, 440–448.<br />
Sue, D. W., Carter, R. T., Casas, J. M., Fouad,<br />
N. A., Ivey, A. E., Jensen, M., et al. (1998).<br />
Multicultural counseling competencies: Individual<br />
and organizational development. Thousand Oaks,<br />
CA: Sage Publications, Inc.<br />
Suinn, R. M., Richard-Figueroa, K., Lew, S., &<br />
Vigil, P. (1987). The Suinn-Lew Asian Self-<br />
Identity Acculturation Scale: An initial report.<br />
Educational and Psychological Assessment, 47,<br />
401–407.<br />
Thompson, V. L. (1995). The multidimensional<br />
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Research in Personality, 29, 208–222.<br />
Trevino, F. M. (1986). Standardized terminology for<br />
Hispanic populations. American Journal of Public<br />
Health, 77, 69–72.<br />
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psychiatry. San Diego, CA: Academic Press.<br />
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and psychotherapy. Washington, DC: American<br />
Psychiatric Press.<br />
Uba, L. (1994). Asian Americans: Personality<br />
patterns, identity, and mental health.<br />
New York: Guilford.<br />
U.S. Department of Health and Human Services.<br />
(1999). Cultural Issues in Substance Abuse<br />
Treatment. Rockville, MD: Substance Abuse and<br />
Mental Health Services Administration, Center<br />
for Substance Abuse Treatment.<br />
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Children and adolescents in community health<br />
centers: Does the ethnicity or the language of<br />
the therapist matter? Journal of Community<br />
Psychology, 22, 153–163.<br />
Scales for practitioners to recognize<br />
cultural identity<br />
Acculturation Rating Scale for Mexican-Americans<br />
(ARSMA)<br />
Cuellar, I., Harris, C., & Jasso, R. (1980). An<br />
acculturation scale for Mexican-American normal<br />
and clinical populations. Hispanic Journal of<br />
Behavioral Sciences, 2, 199–217.<br />
African Self-Consciousness Scale<br />
Baldwin, J. A., & Bell, Y. (1985). The African Self-<br />
Consciousness Scale: An Afrocentric Personality<br />
Questionnaire. The Western Journal of Black<br />
Studies, 9, 61–68.<br />
Black Racial Identity Attitude Scale-Form B<br />
(BRIAS-Form B)<br />
Helms, J. E. (Ed.). (1990). Black and White racial<br />
identity: Theory, research, and practice. New<br />
York: Greenwood Press.<br />
Chinese Values Survey<br />
The Chinese Culture Connection. (1987). Chinese<br />
values and the search for culture-free dimensions<br />
of culture. Journal of Cross-Cultural Psychology,<br />
18, 143–164.<br />
Vega, W. A., & Rumbaut, R. G. (1991). Ethnic<br />
minorities and mental health. Annual Review of<br />
Sociology, 17, 351–383.<br />
<strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs 25
Cultural Adaptation Pain Scale (CAPS)<br />
Sandhu, D. S., Portes, P. R., & McPhee, S.<br />
A. (1996). Assessing cultural adaptation:<br />
psychometric properties of the cultural<br />
adaptation pain scale. Journal of Multicultural<br />
Counseling and Development, 24, 15–25.<br />
Cultural Information Scale (CIS)<br />
Saldana, D. H. (1994). Acculturative stress:<br />
minority status and distress. Hispanic Journal of<br />
Behavioral Sciences, 16, 116–128.<br />
Multidimensional Measure of Cultural Identity for<br />
Latino and Latina Adolescents<br />
Feliz-Ortiz, M., Newcomb, M. D., & Meyers, H.<br />
(1994). A multidimensional measure of cultural<br />
identity for Latino and Latina adolescents.<br />
Hispanic Journal of Behavioral Sciences, 16,<br />
99–115.<br />
Multidimensional Racial Identity Scale<br />
(MRIS)-Revised<br />
Thompson, V. L. (1995). The multidimensional<br />
structure of racial identification. Journal of<br />
Research in Personality 29 (1995): 208–222.<br />
Multigroup Ethnic Identity Measure (MEIM)<br />
Phinney, J. (1992). The Multigroup Ethnic Identity<br />
Measure: A new scale for use <strong>with</strong> adolescents<br />
and young adults from diverse groups. Journal of<br />
Adolescent Research, 7, 156–176.<br />
Suinn-Lew Asian Self-Identity Acculturation Scale<br />
(SL-ASIA)<br />
Suinn, R. M., Richard-Figueroa, K., Lew, S., &<br />
Vigil, P. (1987). The Suinn-Lew Asian Self-<br />
Identity Acculturation Scale: An Initial Report.<br />
Educational and Psychological Assessment, 47,<br />
401–407.<br />
Short Acculturation Scale for Hispanics (SASH)<br />
Marin, G., Sabogal, F., Van Oss Marin, B.,<br />
Otero-Sabogl, R., & Perez-Stable, E. (1987).<br />
Development of a short acculturation scale<br />
for Hispanics. Hispanic Journal of Behavioral<br />
Sciences, 9, 183–205.<br />
White Racial Identity Attitude Scale (WRIAS)<br />
Helms, J. E. & Carter, R. T. (1990). Development<br />
of the White Racial Identity Inventory. In J. E.<br />
Helms (Ed.) Black and White racial identity:<br />
Theory, research, and practice (pp. 67–80).<br />
New York: Greenwood Press.<br />
26 <strong>Getting</strong> <strong>Started</strong> <strong>with</strong> EBPs
DHHS Publication No. SMA-08-4364<br />
Printed 2009<br />
22576.0409.7765020404